Hygiene; Too Important To Ignore

I walked into the home of  an elderly couple and asked them a question which I repeat almost daily, “What is the most important thing we can do for you?” The husband spoke up saying that his wife needed help at least once a week to take a shower. She wasn’t safe doing this activity alone and he wasn’t strong enough to help her anymore.

This is a common circumstance for me to hear. At least half of our calls for service are related to a client’s difficulty managing their hygiene. Most people think of brushing your teeth and hand washing first, but showering and cleaning up after toileting are just as important.

You may say, only once a week? Well, showering once a week doesn’t necessarily mean they are ignoring hygiene the other days of the week. Some people find that the hot water of a shower dries their skin, so they limit the number of times they get in under the water each week. Some people even avoid showers all together because of safety, endurance and/or strength issues.

As a registered nurse, I definitely put hand washing at the top of the list for health and wellness. Simple attention to hygiene can prevent skin rashes, bladder infections, and digestive problems.

It can also make you feel good. The hot water of a shower can lift your spirits. A warm washcloth on your face in the morning will bring sighs of comfort and joy. I’m more likely to smile after brushing my teeth each morning!

This client’s husband’s request was a good enough answer for me. I left their home feeling like we had a good starting point; that is as long as that feeling lasted though. A call from their daughter revealed a doctor’s concern that her mother’s hygiene was not being paid attention to as she was diagnosed with a bladder infection just a week earlier.

The daughter needed me to be the one who addressed the issue. She didn’t want to overstep her part, since her father was trying so hard to remain independent. I planned for the Home Care Aide to make a visit and then report to me her findings. When her visit revealed what the daughter feared, I told the client’s husband that I felt it was necessary for him to allow our Home Care Aide to visit more frequently. He was reluctant, but did accept the help.

When I find myself in the position of telling people what they don’t want to hear I remind myself of our core values. The first is caring, but the second is safety. Our company should never behave in a heartless way, but we do want to keep a high safety standard.

We want our clients to be able to live at home; this means that they will have to learn to accept help. The problem is they did not choose to change, their health did that without them being in control. As a professional, I like to soften the blow, but cannot side step my responsibility. Hygiene and health are too important to ignore.

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A Flat Rate

Care N Assist doesn’t use gimmicks or slick packages to get people to spend money. We charge a flat rate per hour for services. Our rates remain the same regardless of the length of the shift or if the shift is on a weekend. Simple and straightforward billing is something we offer because our clients and/or their loved ones don’t need billing confusion to be added to their list of burdens.

It is common right now to call one of the franchised In Home Care companies and get a list of pricing that would confuse an accountant. I recently saw a flyer advertising a package of services that was designed to make it hard to compare their pricing to the other competition in town. I am frustrated with these sales tactics. I recognize the reasons they are being used, but I don’t like the burden it puts on our clients who already have difficulty managing their affairs.

In Michigan, the average In Home Care company charges are difficult to calculate due to all of the special rates. The lowest rate I have heard is $17 per hour and the highest I have heard is $35 per hour. Genworth Insurance did a study in 2015 that showed the median rate was $20 per hour in that year. The 2017 Home Care Pulse Benchmarking study breaks averages down by shift length showing average rates to be from $21.50 – $28.00 per hour in 2016.

When we started in 2005, we charged our first client $10 per hour. My strongest influence when deciding our rate was affordability. It seemed to me that most companies in business at that time were overcharging their clients. I was naive to the costs of training, insurances, and taxes. As our company grew, We had to make a conscious decision to value our employees; this meant increasing their pay rate and raising our client rates.

Amazingly, as our rates have risen to become standardized compared to most other companies, we have been given greater opportunities. Potential referral sources and clients alike began to view us as being more professional. Of course, our Elite Standards have not changed, but we are now being recognized as the Elite In Home Care and we continue to grow in each of our offices daily.

Today, I believe our rate is both fair to my employees and a great value to our clients. We are not the cheapest company to hire or the most expensive. We are built on a customer service culture and an age friendly business model. Our flat rate is just one way we demonstrate how much we care about our clients.

Home Care Pulse. (2017). The 8th Annual Edition of the Home Care Benchmarking Study 2017 (Vol. 8).

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Why Do We Work @ Care N Assist

It seems to be a hot topic on LinkedIn and other places to talk about employee retention. I am seeing article titles like:  Five Reasons People Leave Their Jobs, or The Top Ten Ways To Keep Your Team Engaged.

When I held my weekly team meeting on Friday morning with my Office Managers and Corporate Officers, my topic was; Why a Home Care Aide choses to work for an agency. I shared statistics and quoted people who research these things. No one seemed surprised by this information. Hiring and managing Home Care Aides is the work we do everyday.

After that, my question to them was, “Why do you work for Care N Assist?”

I expected to hear something along the lines of what motivates me. I have been talking about our goal to help people live at home incessantly for the last couple years. I made a huge deal of getting a client home from a Skilled Nursing Home so many times the response from those around me went from cheering to looks of “We get it… Okay?!”

But I didn’t hear that from this group. One person did say, “Of course, I care about helping people live at home, but…” they went on to talk about what really motivated them. My first reaction was to be sure I framed the question right when I asked it. I questioned myself as to whether or not I had been clear. Then the next person and the next all answered and still nobody seemed to have my answer to the question as their answer.

The majority of their answers were profoundly simple. They talked about having fun at work. They enjoyed their co-workers and felt that they were friends. A few turned my face red as they explained that they worked for Care N Assist because of me, saying I was a great boss… Just in case you are wondering, nobody was given a raise just for saying those things.

These responses surprised me; maybe they shouldn’t have surprised me, but they did. It was refreshing to hear about their friendships. The running jokes and camaraderie is authentic and I certainly enjoy participating in them on a daily basis.

I have often been concerned that I put more pressure on my staff than they would wish to endure. I hold a very high standard when it comes to serving our client’s needs. It seems a combination of clear expectations and some fun has made a winning formula. I’m sure that my wife bringing in chili for lunch a few times may have had something to do with this  positive response too.

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Living In Clothes

How should our clothes fit as we age? Can we still have swag when our body starts to demand certain accommodations? An elderly person may still appreciate style, but find it is hard to keep up. Not that I am recommending skinny jeans for anyone at any age, but have you ever thought about why your Aunt Vergie wears a dress every day.

I personally have to buy my pants a size larger in the waist in order to accommodate my prosthetic leg. I’m not going to mention the actual size, nor do I wish to discuss the other reasons I have had to increase my pant size. My point is that the clothes you choose to wear can help you to be able to live better in them.

Here are a few recommendations from my years of nursing experience…

It is common for persons who are elderly to get cold easily. To help I recommend wearing layers. Materials that are soft underneath and materials with some structure which will resist the elements on the outside. It is also important to avoid clothing that will restrict circulation.

Arthritis or other disabilities impacting dexterity make it difficult to manage zippers and buttons. I remember my grandfather taking his jackets and removing buttons and replacing them with velcro stitched into the material. This allowed him to wear clothes with style without the difficulty of putting them on and taking them off.  

What if you had a colostomy pouch. Suspenders on a larger waisted pant would allow it to function without getting bound up or disconnected due to constriction at the waist. Women may chose to wear a dress, or a high waisted pant that will ride above the pouch.

What if you have back pain. Clothes that are too tight or clothes that have elastic in the waist can press on your hip or spine. Bulky clothing can cause postural problems when sitting or lying down. Be careful to remove old garments and undergarments from your wardrobe if they are causing you problems. Focus on wearing things that match your body structure that will support your posture and allow you to move without causing pain or restriction.

What if you have urgency with urination. Ease in the bathroom may begin to make decisions about what clothing you wear. An elastic waist-band can reduce time required in the bathroom. Be sure your unmentionables are easy to manage also. Darker colors will more easily hide any notice of an accident and would also be something I would recommended when going out in public.

Maybe you have dialysis three days a week and need to be able to expose your fistula or a dialysis port. If you have a port it may be important to wear a shirt that buttons up in the front. If you have a fistula then your arm will need to be exposed without pushing up the sleeve and constricting your blood flow. Usually a sweater or light jacket that you can pull one arm out of with a short sleeve shirt underneath would be appropriate.  

If your clothes fit right, you should hardly notice them as you go about your day. Of course, it is nice from time to time when you get a compliment on the color of a shirt or maybe the style of your shoes. Those things can still happen. Medical complications or age shouldn’t keep you from putting on something nice.

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Working with Disabilities

Individuals with disabilities can have many challenges in life. One of those is living independently in the community. We have the privilege of providing a service that makes this possible for some.

Many advancements have been made in this area in the last 50 years. Things such as, handicap access to public buildings and advancements in technology for those with physical impairments. Though difficulty still exists, the solution is the same as it has been for as long as history documents it. The solution is having real people provide the hands on care that is needed; this is what Care N Assist does.

We go to our client’s homes to provide a service that will support them. This means seeing them on their best days and on their worst days. We may be helping them to accomplish their personal goals or helping them to stay independent as they debilitate. Seeing a client on a bad day can make our work difficult, so we have to prepare our Home care aides to manage that successfully.

We teach our Home Care Aides to assess before responding. This means being a good listener. If they listen well, then they can guide their client in problem solving. Staying calm is also an important skill. Any frustration the client may be directing at us, is rarely caused by us, so I tell our Home Care Aides to let it go. Our help can be a positive and powerful force in our client’s lives. We just have to be willing to play the role of cheerleader in order to combat the depression that often goes hand in hand with disabilities.

Saying the word disabled is not something I like to do. As an above the knee amputee, I refuse to admit my own disability, except in conversation where I find another person may be encouraged to know about it. I wish to focus on my abilities, and work hard to limit my disability. This concept is well known in our business. We are expected to focus on our client’s abilities. It is our job to help them to maintain their abilities and to provide support where they may lack strength or function.

Working in this environment requires problem solving and flexibility from our Home Care Aides. We have to be encouragers and confidence builders. Stacey Zsigo, RN can often be heard telling our aides during training that it takes a caring heart. Having a caring heart is difficult to teach our employees, but it is what makes Care N Assist a wonderful company to work for.

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Home Visit & Medications

Most people know that it is bad when medications prescribed by a physician are not taken as prescribed. It is equally as bad when a physician prescribes new medications without knowing that their client hasn’t taken their current medications properly. It only gets worse when a physician prescribes medications without knowing what another physician has already prescribed.

There can be many moving parts in this process. It is not something that can be blamed on the physician or the patient in most cases. What is for sure is that a skilled nurse can spot these medication mistakes during a home visit.

For example, I drove to visit a new client for medication management a couple months ago. He had been spending all his energy working to get healthy after a spinal stroke. His understanding of his medications was not good.

When I arrived he had two different lists of medication in his home. The lists had problems which I recognized immediately. For one, three different antidepressants were prescribed. He also had multiple pain medications and muscle relaxers prescribed. And last, he was missing three medications.

I spent the next two weeks calling and faxing his doctors and pharmacy. I was trying to straighten out his lists by confirming each medication on the list. It took two weeks because I would have to wait 2-3 days for each response after faxing or calling with a request. When it was all finished, I sent a copy of the revised medication list to both of his doctors and to his pharmacy.

I know this will happen again. The medical system that he is connected to is too busy to see him as important. He is not the kind of patient that will create a fuss to get noticed. It is just a matter of time before one of his doctors or his pharmacy overlooks his needs.

It will be a change in insurance coverage, or a change in his condition that will most likely cause the next problem. Good news for him, he has a skilled nurse making home visits who will be watching for problems if they arise.

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Wealth of Knowledge

It is a very well documented thing that as baby boomers retire they are taking a great wealth of knowledge, wisdom and leadership skills with them. Recently, I had one of those boomers, a daughter-in-law of a client, email me on the weekend asking me to call her on Monday. She had concerns to talk about.

I remember grinning to myself and put a reminder in my phone for Monday afternoon. This kind of interaction is something we invite at Care N Assist. When our clients and their caregivers feel like they can call, I get excited. It’s their respect I want to earn, and that can only be earned when you can talk about both compliments and concerns.

Most of our clients or their family members give us good information. It’s up to us to interpret their message and to find its usefulness. If we start spewing out excuses or fail to listen we are missing out. The value of their comments and the lessons they teach are worth our time.

Most of this generation’s problems are not new. Technology has changed many things, but it doesn’t change the human condition. How we relate to each other and the effort we put into our work does not change. We are fortunate, that in our business we can learn from our clients. Many of them are eager to share their opinions.

I would say that very few of our clients or their family members would qualify them selves as leaders. It’s the combined knowledge and experience that grabs my attention. Their comments are often worth their weight in gold. We just have to take the time to listen.

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